Healthcare Provider Details

I. General information

NPI: 1487828703
Provider Name (Legal Business Name): STEPHANIE LYNN BARBER BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 RENAISSANCE DR STE D
LAS VEGAS NV
89119-6797
US

IV. Provider business mailing address

2275 RENAISSANCE DR STE D
LAS VEGAS NV
89119-6797
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-7716
  • Fax: 702-597-2242
Mailing address:
  • Phone: 702-739-7716
  • Fax: 702-597-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: